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Patients suffering from disorders of the colon, rectum, and anus often complain of vague symptoms. A detailed description of them must therefore be obtained, so that they may be associated with a precise anatomic location to provide a basis for appropriate examinations and a reliable diagnosis. Even without a specific association with a particular location, numerous symptoms nevertheless suggest a probable site of origin. As in all fields of medicine, the assessment of the patient’s history is the single most important piece of data that the physician can obtain. The circumstances in which a symptom appears, its localization, its development, the appearance of secondary associated complaints, and their exact characteristics should all be ascertained in detail.

Patienten, die an anorektalen Erkrankungen leiden, geben haufig nur unbestimmte Symptome an. Daher mus eine genaue Beschreibung dieser Krankheitszeichen erfolgen, damit sie einer genauen anatomischen Lokalisation zugeordnet werden konnen. Dies liefert letztlich die Basis fur geeignete Untersuchungen und eine zuverlassige Diagnose. Bei einer Vielzahl von Symptomen last sich der wahrscheinliche Ursprungsort vermuten, auch wenn eine spezielle Zuordnung zu einer besonderen Lokalisation nicht moglich ist. Die proktologische Anamnese ist daher von groser Wichtigkeit (s. Kap. 3). Die Umstande, unter denen ein Symptom auftritt, seine Lokalisation, Entwicklung und das Auftreten sekundarer Beschwerden sowie deren charakteristische Merkmale sollten detailliert ermittelt werden.

Fluoropyrimidines are commonly used in clinical oncology, but their strong dose-dependent toxicity limits therapeutic application. The synthetic derivative 5′-deoxy-5-fluorouridine (5′-dFUrd) [1] has raised marked interest due to a higher therapeutic index as compared with 5-fluorouracil (5-FUra) or other related compounds [2–4]. It is also a less potent leukopenia inducer [2, 5] and is not as strongly immunosuppressive as other fluoropyrimidines [6, 7]. The biological activity of this pro-drug is dependent upon its enzymatic cleavage to 5-FUra by a pyrimidine Phosphorylase [8–10] which is found in much higher levels in human and animal tumours than in normal tissues, except in the intestinal tract [3, 4, 10–12].

„Es wird mehr versaumt durch Nicht-Schauen als durch Nicht-Wissen. “ Diese Feststellung von Thomas McCrae (1870–1935) unterstreicht die uberragende Wichtigkeit der klinischen Untersuchung fur die proktologische Diagnosestellung. Obwohl die proktologische Konsultation fur den Arzt eine routinemasige Tatigkeit sein kann, ist sie fur den Patienten doch etwas vollig anderes. Dieser kann haufig mit einem Eingriff dieser Art schwer umgehen, besonders wenn es der erste dieser Art ist. Es gibt verschiedene personliche, psychologische und soziale Ursachen fur die — gelegentlich recht lange — Zeitspanne zwischen dem Auftreten der ersten Symptome und der proktologischen Konsultation. Ebenso ist es auch heutzutage nicht ungewohnlich, das Patienten wegen eines proktologischen Beschwerdebilds langere Zeit behandelt werden, ohne das zuvor irgendeine lokale Untersuchung durchgefuhrt worden ist. Daher werden fortgeschrittene Lasionen gelegentlich erst bei der ersten Konsultation beim Spezialisten entdeckt.

In an attempt to improve the prognostic accuracy for colon carcinoma, numerous alternative classifications have been proposed [1–13].

Familial adenomatous polyposis (FAP) is an autosomal-dominant disease with delayed expression, in which multiple polyps develop throughout the colon with a malignant potential of 100%. Genetic counselling and follow-up of patients at risk is essential for presymptomatic diagnosis. Prophylaxis of cancer arising from this condition would greatly improve if a genetic or a congenital phenotypic marker of gene carriers were available.

Patients suffering from anorectal disorders often complain of vague symptoms. A detailed description of these symptoms must therefore be obtained so that they may be associated with a precise anatomic location to provide a basis for appropriate examinations and a reliable diagnosis. Even without a specific association with a particular location, numerous symptoms nevertheless suggest a probable site of origin. The proctologic history is therefore of great importance (see Chapter 3). The circumstances in which a symptom appears, its localisation, its development, the appearance of secondary associated complaints, and their exact characteristics should all be ascertained in detail.

“More is missed by not looking than by not knowing. ” This statement by Thomas McCrae (1870–1935) underlines the paramount importance of clinical examination in protological diagnosis. Although a proctological consultation may well represent a routine professional activity for the doctor, it is quite otherwise for the patient. He or she often finds a procedure of this kind difficult to cope with, particularly if it is the first time. There are various personal, psychological, and social reasons for the interval of time, which may be quite long, elapsing between the appearance of the first symptoms and the proctological consultation. Likewise it is not uncommon, even at the present time, for patients to be subjected to a prolonged treatment for a proctological complaint without any prior local examination being made. This is why advanced lesions may sometimes be discovered at the specialist’s initial consultation.

The assessment and management of fistulae complicating Crohn’s disease present many problems. In order to draw up some guidelines, we have reviewed our recent experience of this problem.